A 61-year-old man presented to the emergency room with left hemiparesis and dysarthria. Brain magnetic resonance imaging showed right middle cerebral artery territory infarction with proximal internal carotid artery stenosis. Carotid endarterectomy (CEA) was performed on the 8th day of admission. After 3 hours of CEA, the patient complained of dyspnea, and stridor was developed. Chest X-ray was performed immediately (Fig. 1), and emergent endotracheal intubation was performed under suspicion of airway obstruction due to hematoma. Neck computed tomography (CT) confirmed hematoma formation around the carotid vessels (Fig. 2). Blood pressure was strictly controlled without discontinuation of clopidogrel, and hematoma was noted to be reduced on a CT scan 10 days after intubation. The patient was extubated without airway problems.
CEA is the standard treatment for symptomatic carotid stenosis [1,2]. A previous study reported that perioperative hematoma occurred in 7.1% of patients after CEA and was associated with increased perioperative stroke and mortality [3]. Neck hematoma is potentially life-threatening because it can cause respiratory failure and often requires airway management [2]. Suspicion of neck hematoma is crucial if the patient complains of respiratory discomfort after CEA, and airway management should be performed immediately [2]. Checking the chest X-ray can provide guidance in the differential diagnosis of respiratory discomfort after CEA.
PDF Links
PubReader
ePub Link
XML Download
Full text via DOI
Download Citation 
Print 
